Deviated Septum

What Is It?

The nasal septum is the wall between the left and right sides of the nose. It is firm, but bendable, and it is covered by skin that has a rich supply of blood vessels. Ideally, the nasal septum should lie exactly in the center, so that the left and right sides of the nose are of equal size. In about 80% of us, however, the nasal septum is a little off-center, although most of us never notice. Less often, the septum is more dramatically off-center. This is called a deviated septum.

In people who have a deviated septum, one side of the nose is wider than normal and one is narrower. This alters the pattern of airflow in the nose and sometimes blocks the narrowed side. In some cases, sinus openings can be blocked, triggering a sinus infection (sinusitis) that lasts a long time or keeps returning. The altered airflow pattern within the nose can cause the skin of the nasal septum to become dry and cracked, which can cause frequent nosebleeds.

Some people are born with a deviated septum because the nose developed that way before birth. A deviated septum can also be caused by injury to the nose during birth. Later in life, a deviated septum can be caused by trauma, although adults and teenagers often cannot remember the injury that caused the problem. In most cases, however, it was probably a blow to one side of the nose — often during contact sports, playground games, or a traffic accident — that knocked the nasal septum out of position.

Symptoms

Symptoms of a deviated septum can include:

• Blockage of one or both nostrils
• Nasal congestion, sometimes on one side
• Frequent nosebleeds
• Frequent sinus infections
• Facial pain, headaches, postnasal drip
• Noisy breathing during sleep in infants and young children

In some cases, people with a mildly deviated septum have symptoms only when they also have a cold or other upper respiratory tract infection. In these people, the respiratory infection causes nose tissues to swell, which can make airflow problems worse. Once the cold goes away, the symptoms of a deviated septum often go away, too.

Diagnosis

After reviewing your symptoms, the doctor will ask you whether you have ever broken or severely injured your nose and whether you have ever had nasal surgery. Your doctor will look at your nose and the position of your nasal septum. Your doctor will use a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril. The lining tissues of the nose may be temporarily shrunken by use of Afrin or Neo-Synephrine nasal spray to get a better look at the entire septum. Sometimes a fiberoptic scope will be inserted in the nose to look at the posterior septum directly. In most cases, you will not need any special tests.

If your deviated septum is causing troublesome nosebleeds, repeated sinus infections or other significant problems, then your primary care doctor will refer you to an otolaryngologist (ear, nose and throat specialist) or plastic surgeon for treatment.

Expected Duration

A person with a mildly deviated septum may have symptoms only during an upper respiratory tract infection. Someone with a more severe deviation may develop chronic sinusitis or recurring nosebleeds that will last until the problem is corrected surgically.

Prevention

You can help to prevent a deviated septum by avoiding injury to your nose. To do this, wear seat belts and shoulder harnesses whenever you ride in a car and wear well-fitting headgear to protect your face during contact sports, such as football or karate.

Treatment

If you have a deviated septum, talk with your doctor about the need for a type of surgery called septoplasty. In this procedure, the surgeon will move your septum to a normal position. In some cases, the surgeon also will reshape the external appearance of your nose in a procedure called rhinoplasty. When the two procedures are done at the same time, the surgery is called a septorhinoplasty.

If your child has a deviated septum, the doctor may wait until your child's nose has finished growing before doing surgery. In most cases, this is not until age 15 or 16. Boys usually need to wait a little longer than girls because they finish growing a little later.

When To Call A Professional

If your child has a deviated septum, the doctor may wait until your child's nose has finished growing before doing surgery. In most cases, this is not until age 15 or 16. Boys usually need to wait a little longer than girls because they finish growing a little later.

Prognosis

In the most cases, surgery is successful. However, a small percentage of patients choose to have a second surgery for cosmetic reasons or to improve airflow.

Additional Info

National Institute of Allergy and Infectious Diseases (NIAID)
http://www.niaid.nih.gov/

American Academy of Otolaryngology — Head and Neck Surgery
http://www.entnet.org/

American Academy of Oral and Maxillofacial Radiology
http://www.aaomr.org/

American Society of Plastic Surgeons
http://www.plasticsurgery.org/